title: Modifiable factors in access to living-donor kidney transplantation among diverse populations.
abstract: BACKGROUND
  We have observed a significant inequality in the number of living-donor kidney transplants (LDKT) performed between patients of non-Western European origin and those of Western European origin. The aim of this study was to investigate modifiable factors that could be used as potential targets for an intervention in an attempt to reduce this inequality.
  
  
  METHODS
  A questionnaire on knowledge, risk perception, communication, subjective norm, and willingness to accept LDKT was completed by 160 end-stage renal patients who were referred to the pretransplantation outpatient clinic (participation rate of 92%). The questionnaire was available in nine languages. Multivariate analyses of variance were conducted to explore differences between patients with and without a living donor.
  
  
  RESULTS
  There were significantly fewer patients of non-Western descent (11 of 82) that brought a living donor to the outpatient clinic than patients of Western descent (38 of 78). After correcting for the unmodifiable sociodemographic factors non-Western descent, low knowledge, little communication about their kidney disease, and low willingness to communicate with individuals from the social network about LDKT were significantly associated with the absence of a living donor.
  
  
  CONCLUSIONS
  Knowledge and communication are identified as modifiable factors that are associated with the likelihood of identifying a potential living donor for LDKT. This observation makes knowledge and communication targets for interventions to reduce inequality in access to LDKT.
authors.affiliation: 1 Psychiatry-Medical Psychology and Psychotherapy, Erasmus MC, CA Rotterdam, The Netherlands. 2 Internal Medicine-Nephrology & Transplantation, Erasmus MC, CA Rotterdam, The Netherlands. 3 Address correspondence to: Sohal Y. Ismail, M.Sc., Psychiatry-Medical Psychology and Psychotherapy, Erasmus MC, Postbox 2040, Room GK-1252, 3000 CA Rotterdam, The Netherlands.
authors.forename: Sohal Y
authors.initials: SY
authors.lastname: Ismail
authors.forename: Annemarie E
authors.initials: AE
authors.lastname: Luchtenburg
authors.forename: Judith A
authors.initials: JA
authors.lastname: Kal-V Gestel
authors.forename: Willij C
authors.initials: WC
authors.lastname: Zuidema
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: Emma K
authors.initials: EK
authors.lastname: Massey
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003142:Communication; D003376:Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors / Q000523:psychology / Q000600:supply & distribution*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010353:Patient Education as Topic; D012017:Referral and Consultation; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology